Prevention and Treatment of Glucocorticoid-Induced Osteoporosis in Adults: Consensus Recommendations From the Belgian Bone Club

Frontiers in Endocrinology

Evelien Gielen¹  Etienne Cavalier³  Bruno Lapauw⁴  Charlotte Verroken⁴  Michaël R. Laurent⁵  Serge Rozenberg⁶  Jean-Jacques Body⁷  Pierre Bergmann⁸  Stefan Goemaere⁹  Olivier Bruyère^1,10 

[1] 0Gerontology and Geriatrics section, Department of Public Health and Primary Care, University Hospitals Leuven and KU Leuven, Leuven, Belgium;Centre for Metabolic Bone Diseases, Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium;Department of Clinical Chemistry, University of Liège, CHU de Liège, Liège, Belgium;Department of Endocrinology and Metabolism, Ghent University Hospital, Ghent, Belgium;Department of Geriatrics, Imelda Hospital, Bonheiden, Belgium;Department of Gynaecology and Obstetrics, Université Libre de Bruxelles, Brussels, Belgium;Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium;Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium;Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium;WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium;

关键词: adults;    Cushing syndrome;    glucocorticoid-induced osteoporosis;    glucocorticoids;    osteoporosis;    prevention;   

DOI  :  10.3389/fendo.2022.908727

来源: DOAJ

【 摘 要 】

Glucocorticoids are effective immunomodulatory drugs used for many inflammatory disorders as well as in transplant recipients. However, both iatrogenic and endogenous glucocorticoid excess are also associated with several side effects including an increased risk of osteoporosis and fractures. Glucocorticoid-induced osteoporosis (GIOP) is a common secondary cause of osteoporosis in adults. Despite availability of clear evidence and international guidelines for the prevention of GIOP, a large treatment gap remains. In this narrative review, the Belgian Bone Club (BBC) updates its 2006 consensus recommendations for the prevention and treatment of GIOP in adults. The pathophysiology of GIOP is multifactorial. The BBC strongly advises non-pharmacological measures including physical exercise, smoking cessation and avoidance of alcohol abuse in all adults at risk for osteoporosis. Glucocorticoids are associated with impaired intestinal calcium absorption; the BBC therefore strongly recommend sufficient calcium intake and avoidance of vitamin D deficiency. We recommend assessment of fracture risk, taking age, sex, menopausal status, prior fractures, glucocorticoid dose, other clinical risk factors and bone mineral density into account. Placebo-controlled randomized controlled trials have demonstrated the efficacy of alendronate, risedronate, zoledronate, denosumab and teriparatide in GIOP. We suggest monitoring by dual-energy X-ray absorptiometry (DXA) and vertebral fracture identification one year after glucocorticoid initiation. The trabecular bone score might be considered during DXA monitoring. Extended femur scans might be considered at the time of DXA imaging in glucocorticoid users on long-term (≥ 3 years) antiresorptive therapy. Bone turnover markers may be considered for monitoring treatment with anti-resorptive or osteoanabolic drugs in GIOP. Although the pathophysiology of solid organ and hematopoietic stem cell transplantation-induced osteoporosis extends beyond GIOP alone, the BBC recommends similar evaluation, prevention, treatment and follow-up principles in these patients. Efforts to close the treatment gap in GIOP and implement available effective fracture prevention strategies into clinical practice in primary, secondary and tertiary care are urgently needed.

【 授权许可】

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